Revision ACL Reconstruction

One of the most common knee injuries is a torn ligament, and the anterior cruciate ligament (ACL) is the one we often read about in the sports pages. Athletes who participate in cutting and pivoting sports such basketball, soccer, football, skiing and lacrosse are more prone to an ACL injury.

Many people, especially younger active patients or athletes seeking to return to a sport, opt for surgery to repair the torn ligament. About 100,000 ACL reconstructions are performed in the United States each year, and overall, it is a highly successful operation. Innovative surgical techniques allow us to more precisely reproduce the anatomy and function of the original ACL.

Although primary ACL reconstruction has a high success rate, some patients are left with unsatisfactory results or they re-injure the ligament. About 10 percent of the ACL reconstructions performed in the United States fail within 10 years.

The main reasons a patient might need a revision ACL reconstruction include re-injury, problems arising from the previous surgery, or failure of the reconstructed ligament to heal properly.

Generally, patients know when there is a problem. Even after extensive rehabilitation, they may experience recurrent instability or other symptoms. After a primary ACL reconstruction, patients must also avoid returning to a sport too soon.

A second surgery to repair a torn anterior cruciate ligament is called revision ACL reconstruction. This is a more challenging operation for the orthopedic surgeon. Primary ACL reconstructions are performed using different techniques, so the surgeon must take multiple factors into account when planning for the more complex procedure.

The decision to proceed with a second ACL surgery depends on the patient, the condition and stability of his or her knee, the desired activity level and imaging findings. Patients are advised to seek out a specialist with ample experience in revision ACL surgery for the best chance of a good outcome.

A number of options exist for revision ACL reconstruction, including using one of the patient’s own tendons. The patellar tendon, quadriceps tendon, hamstring tendon or allograft tissue may be used. The use of a tendon from the patient’s other knee is sometimes considered, as well.

Because revision ACL reconstruction is a more difficult operation to perform compared to primary ACL surgery, patients should choose an orthopedic surgeon with ample experience and with whom they feel comfortable. The doctor should take the time to answer all of a patient’s questions in nontechnical terms. With careful planning, many patients can have excellent results and return to a very high level of activity without knee instability.

Many, but not all, patients opt for revision surgery. People who do not experience instability in their knee and do not wish to return to cutting and pivoting sports may decide not to have surgery. If they wish to remain active, they may engage in a different sport. However, patients who are left with an unstable knee or are enthusiastic about returning to their athletic activity of choice generally opt for revision surgery.

In general, rehabilitation following ACL revision reconstruction is similar to physical therapy after primary ACL reconstruction. Sometimes rehab after revision surgery takes a bit longer.

When considering whether or not to have a second ACL surgery, patients might want to ask their doctor the following questions:

Why was the first operation unsuccessful?

What will happen if I don’t have revision surgery?

Do I have any other knee injury, such as a torn cartilage, that may affect the outcome of revision surgery?

What will my recovery and rehabilitation be like?

What are the risks of surgery?

How can I avoid re-injuring my knee?

Patients are also advised to inquire about the doctor’s experience in ACL revision surgery, as well as the hospital’s safety and infection rates.

The best way to avoid revision ACL surgery in the first place is to do certain exercises to increase strength and balance. The other option is to stop playing cutting and pivoting sports, substituting other athletic activities in which the risk of ACL injury is low. Such activities include swimming, cycling, jogging and weight training.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Hello,i had a primary ACL recostruction before 1,5 year , but the graft it was failed because of agressive physiotherapy in the early stage(lengthening of hamstring graft because of active leg extension with gravity 1 week after the operation ) so i had a revision before 5 months(1 year after the primary).My muscles were very weak before revision(just jogging) and i afraid that i can”t get my muscles back.5 months after revision i started jogging(very slow) but my muscles are very very weak.I would like to know your opinion about the failure of the graft and about the athletic activity which i can have after ACL revision.THANKS

Hi Kostas, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “Recovery after revision ACL reconstruction can take longer. The cause you describe for failure may not be accurate as it is impossible to know without more information. Some patients can be very active after revision ACL reconstruction. Be patient, make gradual progress and hopefully you will be able to return to what you want to do.”

Hello, I had a complete tear of my ACL 32 years ago. The tear was misdiagnosed initially. Finally a year later when the leg muscles were not as strong, an orthopedic surgeon did a scope and found the torn ACL, no cartilage damage. He removed the ACL. After discussing the alternatives we opted not to do the reconstruction. Now I am having problems with my knee. Has is been too long to have ACL reconstruction? I am now 51 years old and in good shape.

Hi Keith, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “ACL reconstruction can be performed many years after the original injury, even decades. The main question is whether the ACL is the problem or whether you have developed arthritis or another problem. To answer this question, consultation with a knee specialist is necessary.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

I’m 10 months post primary ACL surgery. Had been fully cleared to resume sports (Been cleared to begin jogging over 6 months ago). Knee felt great, really strong.
Was jogging this past week end, felt a pop there was no pain in the initial pop but felt additional pain throughout the knee…Now two days later have a lot of pain behind the knee…it’s stable but, it’s stiff and I have a lot of pain. Does this sound like a re-tear? I can’t get in my doctor’s for four days and I’m dying to know.

Hi David, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “Although it doesn’t usually happen with jogging, it could possibly be a retear. You should consult with your surgeon.” For more information on ACL injuries, visit http://www.hss.edu/condition-list_acl-injuries.asp. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Hello,Now i am 21 years old.I had a complete tear of my ACL without any meniscui damage,i had a primary ACL recostruction before 6 months,but after surgery the tendon site was not healed due to infection,doctor found that after one month of surgery and he done arthosocpe knee wash and he told me to take 45 days bed rest.After 45 days i felt instability on knee.I went to doctor he said there is laxity between grade 1 and 2,and he also said there is rotational inconsistency.So he told me that i cant run any more in life and suggested to use hinged knee brace for life long.I am feeling pain some times.I want to get my previous life back.Is there any treatment other than REVISION ACL RECONSTRUCTION for getting into my previous life activity.

Hi Krishna, thank you for reaching out. It is best for you to seek an in-person consultation with a physician so they can better advise. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Hello. I am 10 months post revision on my left knee. Hamstring allograft failed after 9 months due to lack of therapy and aggressive return to sport (indoor and college soccer). I feel fine and stable. However, in certain positions and when I bend my knee inwards I feel like the inside of my calve muscle is very weak and gets stretched. Close to the MCL area. Is this common? Does the calve really protect the ACL that much?

Hi Victor, thank you for reaching out. For more information on ACL injuries, please visit http://www.hss.edu/condition-list_acl-injuries.asp. It is best for you to consult with your treating physician who is familiar with your course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

This is very well written. Having gone through ACL reconstruction myself, I can tell that this would serve as a good resource for people who just got injured and don’t know what to expect. It even goes further to talk about revisions.

Is there any data that details the success rates for revisions, 3rd surgery, 4th etc? I’d be interested to see that. Also, what is the rate of re-tear at the 2 plus years post surgery mark. I’m assuming the rate of re-tears at this stage goes down considerably?

Hi Chuba, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “There is very little data on multiple ACL revisions. Commonsense would have it that more revisions on the same knee has a higher risk of potential problems. In the recent text book on ACL revision, we dedicated an entire chapter to the multiply revised ACL knee. The rate remains to be approximately 1 percent per year, based on the published literature.”

Hi my name is Elena. I am a 17 year old girl who is involved in many sports (lacrosse,soccer, swimming, cross country, ultimate frisbee). About two years ago I tore my ACL and had it reconstructed, using hamstring auto graft, a month later. I went through physical therapy and was cleared to play after about 8 months. Now 2 years late I found out that I have retorn my ACL and have a partial meniscus tear as well. Although I don’t play lacrosse or soccer anymore I do run, yoga, swim and play pick up frisbee games. I was wondering if the revision ACL reconstruction surgery was worth it if it tore so easily the first time.

Hi Elena, thank you for reacing out. Unfortunately, we are not able to answer your question because you are under the age of 18. It is best for you to consult with your treating physician with a parent.

Hello, I am a 30 year old female. I had ACL reconstruction in 2002. I tore the same ACL in 2006 and had a revision using a patellar cadaver. I was completely cleared after PT, but have been much less active and constantly avoiding activity that could cause an ACL tear. I worry that I am prone to this injury and definitely don”t want another surgery, but at the same time I feel as if I am missing out on my favorite activities. Specifically, I want to tumble again which would require punching/rebounding and landing. I also may want to take up crossfit. Do you feel that it would be better to continue avoiding activities with impact, or that it would be safe to give it a shot? Do you know the odds of tearing a revision? Thanks in advance!

Hi Barbara, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “Return to activity is a very personal decision. Activities such as tumbling increase the risk of reinjury and revision. Re-tear is more likely after revision ACL than a primary. At the end of the day, it is up to the patient to decide what is important to them and what their risk tolerance is.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

I”m a 16 year old female and have torn my acl twice due to soccer injuries. I am 3 months out from the revision surgery. I would like to be playing soccer at 6 month. Would that be unsafe or bad on the graph? I used my hamstring graph. My doctor would like me returning closer to 9-12 month, but with hardwork and destination to physical therapy would it be possible to return to soccer at 6 months?

Hi Emily, thank you for reaching out. Unfortunately, we are not able to answer your question because you are under the age of 18. It is best for you to consult with your treating physician with a parent.

Hi there, my name is Courtenay. I am a d1 level soccer player. Last spring, I completely tore my ACL, tore my meniscus on both sides, slightly tore my MCL, and had several contusions and sprains. I went through reconstructive surgery a month after the incident and used my own hamstring graft. After surgery, I went to physical therapy gruelingly. I have recently been back at practice playing hard and trying to get back in shape. However, I can sense that something is off. I feel a lot of tension mid calf, through the knee and up towards my hamstring every time I flex my quad. I also feel pain in my knee while flexing. Actually I feel pain all the time. My knee has given out on my several times since surgery. Do you think the surgery failed? What does this mean my next steps are?

Hi Courtenay, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “It is impossible to say if the surgery failed without seeing you. However, medical evaluation is necessary in view of your symptoms. This would include an in person physical examination as well as review of imaging studies. Based on the story, it is certainly possible that the graft is not intact.” If you are interested in receiving care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Sir, I am 50 years old. 5 months ago I had a fall from my bike and MRI confirmed :
a) Complete tear of the midportion of ACL
b) Large redial tear of posterior horn of the medial menicus with reactive marrow oedema in posterior aspect of the medial tibial condyle
c) small joint effusion
Some doctors say ACL reconstruction is required and some said NO to surgery as I have crossed 40 yrs. I am not sportsman but do lot of walking and little bit of running to catch my train or buses. Coming to my present status, after 5 months of my injury I still feel some sort of stiffness which prevent me from normal way of walking. This stiffness is not there during morning hours but feel during late evening and sometimes pain somewhere inside my knee. Gives uncomfortable feeling while walking and sometimes pain when I place my leg in a pit by mistake. So far I have never tried to run after the injury. Please advise me whether surgery is required. Why do I get this uncomfortable feel when I walk. Whether I can try to run a short distance. I shall be thankful if my above queries are answered.

Hi Vivek, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “It is impossible to know whether surgery is necessary without an in person evaluation to examine the knee and also review the imaging studies. Based on your story, it is certainly possible that surgery would be beneficial for you.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Hello sir
I am 24 years old, when i was 22 had undergone meniscus and acl reconstruction now after 2 years i feel my left knee as instability but too every morning i go for slow jog basic exercise. now one of my doctor suggests me to undergo acl revision as clinically there is a tear for acl. can you please suggest me weather i should undergo the surgery or not? if so then how many days i need to get back to my normal life so that i can go to my office at least?

Hi Chetan, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “If the instability is a problem for you, it could be improved with ACL revision reconstruction. However, that must be determined by a careful evaluation of your symptoms, physical examination and imaging studies. An in person consultation is required. In general, patients can go back to work one week after revision ACL reconstruction.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

I had torn my ACL of right leg when I was 18 and got the reconstruction done at the age of 31. Started playing after 2.4 years of my operation/completed PT/rehab and recently landed on my left knee with full extension causing grade 2 tear and did hurt my right knee (operated one) as well. Have got the MRI done and it’s shows the right knee’s ACL as intact, however my right knee Hi,

I had torn my ACL of right leg when I was 18 and got the reconstruction done at the age of 31. Started playing after 2.4 years of my operation and recently landed on my left knee with full extension causing grade 2 tear and did hurt my right knee (operated one). Have got the MRI done and it shows the right knee’s ACL as intact, however my right knee now pivots but otherwise is stable. I may have to get the reconstruction done of my left along with menistomy, please advice if I should get the second reconstruction done of my right knee. In case I plan not to proceed with right knee operation, can it cause arthertis at a later stage as knee pivots, I have already decided to avoid football (which I loved), but will continue with jogging etc.

Hi Sumit, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “The indications for primary reconstruction or revision reconstruction are similar. Reconstruction is generally recommended for recurrent instability or for patients who want to resume cutting and pivoting sports. If these apply, I would recommend considering surgery.” If you are interested in receiving care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

I had ACl reconstruction surgery last February. Lastly I have been feeling like my knee could give out at any time. I was recently walking down some stairs and heard a “pop”. My knee then became extremely swollen and has been for the next 5 day. The swelling is still not completely gone. Could I or re-tore my ACL?

Hi Shaye, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “It sounds as if you did tear your ACL. You would need to see a doctor for an evaluation to assess the integrity of your ACL graft.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Hi Rajat, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “Every surgery is different and it is recommended that you ask your surgeon. In general, recovery after revision surgery is longer than after a primary operation.” It is best that you consult with your treating physician so that they can determine the best course of treatment. If you wish to receive any care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Hi, I had ACL grade 3 tear and minute meniscus damage in 2009 for which I was operated in July 2009. I returned to playing football 8 months after the surgery and played decent for around 3 yrs. In February this year I had a bad knock on the same knee while playing. Initially I did not fear it to be a re-tear and continued jogging and gyming. However after 3-4 months when I tried playing football again I felt a bit of instability in the knee. This instability has since then been there and when I consulted a ortho, he recommended me for an MRI. The result of the MRI suggested that, the reconstructed acl is all but gone once again and there is mild joint effusion and minimal tear in the meniscus as well. I have decided to go for a revision surgery. The surgeon is quite experienced and has a fellowship in sports medicine as well. He has given me enough confidence that I will be able to regain strength and return to playing football again keeping in mind that I will have to be very careful as well.

But after going through a lot of blogs I am concerned that whether a revision acl surgery will be a good option or not. Will I be able to carry out my day to day activities or not? Whether I will be able to play again or not? Been a working personal, I have to manage my work as well. So will it take a lot of time and rehab to gain fitness again? I am really very tensed.

Hi Himanshu, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “Revision ACL reconstruction is complex and each case is different. It is difficult to offer useful information on your case without seeing you in person.” It is best for you to consult with a physician so they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

I have had 2 ACL reconstructions thus far and I just found out that I torn my ACL for a third time. I have seen 3 doctors and 2 surgeons have told me to have it repaired and the other told me to leave it alone. I just want to know what I should do and if you could recommend any surgeons in SC or GA.

Hi Amanda, thank you for reaching out. It would be best for you to seek surgical consult with a physician. If you wish to receive care at HSS, please contact our Coast to Coast (C2C) Program at 212-606-1610 or via email at C2C@hss.edu for further assistance. For more information on the Coast to Coast (C2C) Program, please visit http://www.hss.edu/coast-to-coast.asp.

I have had 3 surgical consults. Two of which said for me to not have a third ACL reconstruction. Would you recommend a third ACL reconstruction to someone who is on their legs a lot for work and has a very active lifestyle.

Hi, i recently had an acl reconstruction last december 2 and now i am in the first phase of rehab session. I am just worried and anxious because the day after the surgery of my right knee, the surgeon already checked and cleaned the stitches and asked me to bend the knee slightly. After i have bent a small degree, i felt something but i dont know if it is a ‘pop’ or what, but i felt a sudden sting/pain in my knee initially after bending a small degree that i did not continue bending it for that time. Considering that it is only 1day after the surgery, i ignored it. Days past and i am being paranoid of what could be that sound i heard that definitely came from my knee. In your expertise, is that a re-tear? Can there be a re-tear immediately after the surgery? Thank you very very much!

Hi Troi, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “It sounds like you could be experiencing something that is normal following surgery. The only way to know for sure is to follow up with your physician.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Hi Troi, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “It sounds like you could be experiencing something that is normal following surgery. The only way to know for sure is to follow up with your physician.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Hi. My 16 year old son tore his acl last year and partially tore his mcl. Over a year later he a kid rams his leg during a basketball game and his knee swells up. Hes able to still walk, has little pain for a day or so, swelling gone after acouple of days. After a long Christmas break with no sports, we decide to have dr clear him before going back to school. He says he overextended. …he hasnt had any pain, swelling, loss of motion/range, no instability. NOTHING. He wants orthopedic surgeon to give “blessing ” since it was repaired prior. That dr says torn again and mcl as well. My son is so confused. …..he still remembers the first injury. Just makes no since.

Hi Brandy, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “It sounds like the ACL graft is torn and your son should see a doctor to examine the knee.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Hi Joe, thank you for reaching out. It would be best for you to consult with your treating physician who is more familiar with your medical history so they can determine the best course of treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

Hi, I’m currently 40 and had a complete tear of my right knee ACL from playing soccer. I had primary ACL reconstruction surgery using my own patellar tendon graft and meniscus repair in 2007, after about a year of rehab I started playing soccer again and eventually got into road biking and running as well (both trail and road), to the point of completing several half marathons and full marathons. Last year in April during a soccer game I injured myself again, I heard the pop and later an MRI showed the ACL being torn. Since then I stopped playing soccer and dedicated myself to just running at a lower pace and have yet to feel any instability at all. I’m still not fully convinced of having a revision done, but it worries me that because I have a tore ACL I might damage other parts of my knee from jogging or running, is that a valid concern?

Hi Carlos, thank you for reaching out. Dr. Robert Marx, Orthopedic Surgeon, says: “If there is no instability, pain or other symptoms, it may be reasonable to hold off on surgery, depending on your specific clinical situation and a discussion with a knee specialist.” If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

I had ACL reconstruction back in 2006 with a hamstring graft. The ACL never failed but the tunnel and new ACL was so vertical my knee was able to rotate and tore my lateral meniscus. November 2014 I had that ACL removed and a new tunnel drilled in a more anatomical position with a cadaver ACL. Is this common or have you heard of this issue with old ACL procedures?

Hi, I recently had a revision ACL reconstruction. This is my second one in two years. Although I had sergury the first time and feel like I should know what’s coming, I don’t. I tore it playing basketball for my Highschool league. The surgery was basically the same except my doctor also had to repair my MCL, because it too was damaged in my injury. I’m still on crutches and knee still looks like the size of Mars. Would you happen to know when I’d be able to start walking again and when the swelling would ease up a little. So far I’ve been on crutches for a week and five days.

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